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People with BPD have high rates of presentations to healthcare services (Shaikh et al. 2017), often in crisis following self-harm or a suicide attempt (Ferguson 2016). People with BPD also experience stigma when they attempt to access healthcare services (McMahon & Lawn 2011; Lawn & McMahon 2017) at higher rates than people with other mental illnesses. Literature continues to highlight the importance of addressing this stigma to improve health services and the quality of care offered to people with BPD (Fergusion 2016; Warrender et al. 2020). Educational interventions, such as anti-stigma interventions, that focus on modifying clinicians’ attitudes and practice to consumers with BPD, may assist in achieving these outcomes (Warrender 2015). The aims of this systematic review are to: 1) identify and explore the international peer-reviewed literature on educational interventions designed to modify clinicians’ attitudes and practice in treating consumers with BPD, including interventions that address stigmatising beliefs and behaviours in healthcare systems; 2) determine whether educational interventions can advance clinicians’ attitudes and practice in treating consumers with BPD. Ferguson A. Borderline personality disorder and access to services: a crucial social justice issue. Aust Soc Work. 2016;69(2):206-14. Lawn S, McMahon J. Foundations for change: part 2 - consumers: experiences of consumers with the diagnosis of BPD: 2017 update. Marden, South Australia; 2017. McMahon J, Lawn S. Foundations for change: part 1- consumers: experiences of consumers with the diagnosis of Borderline Personality Disorder (BPD). Marsden, South Australia; 2011. Shaikh U, Qamar I, Jafry F, Hassan M, Shagufta S, Odhejo YI, et al. Patients with borderline personality disorder in emergency departments. Front Psychiatry. 2017;8:1-12. Warrender D, Bain H, Murray I, Kennedy C. Perspectives of crisis intervention for people diagnosed with 'borderline personality disorder': an integrative review. J Psychiatr Ment Health Nurs. 2020;00:1-9. https://doi.org/10.1111/jpm.12637.

Background Structural stigma in health systems experienced by consumers diagnosed with Borderline Personality Disorder (BPD), is a widespread phenomenon that causes major health inequities and harm for this population. Structural stigma in this context relates to institutional policies, cultural norms and organizational practices that limits consumers’ access to health services, quality of care, and capacity to achieve optimal health and well-being. BPD is a serious mental illness with high morbidity and mortality, characterized by instability in interpersonal relationships, self-image, and emotional and behavioral deregulation, which stem from significant traumatic childhood/life events, and/or biological aetiologies. The objectives of this scoping review are to explore the international literature on structural stigma in healthcare systems specific to BPD, and to provide an overview of the impact of structural stigma on health services for BPD consumers, and their carers/families.Methods This scoping review will follow the Joanna Briggs Institute (JBI) scoping review guidelines. We will search the following electronic databases (from inception onwards): MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library and JBI-Evidence databases. Grey literature will be identified through the Google search engine. We will include all types of literature in English, published and unpublished, including any study design, reviews, clinical practice guidelines, policy reports, and other documents. No restrictions on publication date of sources of evidence will be applied. International literature should examine structural stigma associated with BPD in any healthcare setting such as, outpatients, inpatients, primary health care, or community-based facilities. Two reviewers will independently screen all titles, abstracts and full-text citations. Quality appraisal of the included sources of evidence will be assessed using the Mixed Methods Appraisal Tool (MMAT) 2018 version. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., thematic analysis) methods. Discussion This review is anticipated to enhance both identification and understanding of those structures in health systems (i.e., institutional policies, cultural norms, and practices), that manifest and perpetuate stigma experienced by consumers with BPD, and their carers/families. The findings can be used to inform future research, policy and practice relating to stigma reduction strategies that can be adopted to improve the provision of BPD-responsive services and care for this population. Scoping review registration This scoping review protocol was submitted for registration within Open Science Framework on 11th June 2020. This review protocol can be viewed via the following link: DOI 10.17605/OSF.IO/NWSVD

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This article appeared in a journal published by Wiley-Blackwell. Under Wiley's copyright, mandated authors are not permitted to make work available in an institutional repository., Objective: In the DSM-5 diagnostic criteria for eating disorders, two main groups appear, threshold eating disorders (TED; anorexia nervosa, bulimia nervosa and binge eating disorder), and Other Specified Feeding and Eating Disorders (OSFED). In addition to calculating prevalence of these two groups, we examined the degree to which they could be differentiated in terms of impairment and risk factors. Method: Adolescent female twins (N=699) were interviewed with the Eating Disorder Examination on three occasions spanning 12.70-19.84 years of age. Assessments also included self-report measures related to impairment and risk. Results: Prevalence of DSM-5 ED in this adolescent population was 10.4%; 5.4% for TED and 5% for OSFED. Impairment levels did not distinguish TED and OSFED groups at any wave. Examination of latent risk factors showed TED and OSFED groups to share a common genetic basis; however, largely non-overlapping unique environmental influences contributed to the two groups. Specific risk factors commonly differentiated the no ED and TED groups, but not OSFED. Discussion: The findings suggest that TED and OSFED groups cannot be discriminated by prevalence or impairment or genetic risk factors. It is anticipated that OSFED will possess limited clinical utility for adolescents. Future research should examine clinical cases of these two groups in terms of meaningful differences, and a research focus should be maintained on both groups. Further examination of specific environmental risk factors that may attenuate the level of symptoms between the two groups may provide useful information for prevention efforts., Australian National Health & Medical Research Council